Avena 2015.

Study characteristics
General information	Objective  Prediction model compared Journal Arquivos Brasileiros de Cardiologia Country Brazil Study design Prospective cohort study
Participants	Number of included patients 141 Surgical specialty Vascular surgery Age 66 years Male sex 65% High‐risk surgery Not reported Insulin‐dependent diabetes mellitus Not reported History of ischaemic heart disease 39.7% History of congestive heart failure 54.6% History of cerebrovascular events Not reported Elevated creatinine Not reported 0 RCRI factors 4.3% 1 to 2 factors 44.7% 3 or more RCRI factors 51%
Predictors	Predictor 1: Vascular study group of New England cardiac risk index (VSG‐CRI)  Objective: prediction model compared Category: prediction model  Scale: categorical Threshold: 0 to 4 = low; 5 to 6 = moderate; > 6 = high risk Assay/device: not applicable
Outcome	Outcome category All‐cause mortality; MACE; all‐cause mortality and MACE Full outcome definition MACE was defined as nonfatal myocardial infarction, decompensated heart failure, significant arrhythmia and stroke Prediction horizon 30‐day events
Analysis	Number of outcomes 39 Handling missing data No information on handling missing data Discrimination reported? Yes Calibration reported? No Reclassification reported? No
PROBAST: Applicability	Domain 1: Participant selection High Justification: included patients have very high incidence of comorbidities Domain 2: Predictors Unclear Justification: no information on predictor definitions Domain 3: Outcome High Justification: outcome does not match outcome of the development study Overall judgement High Justification: only a selected group of patients was included, there was no/unclear information on predictor definitions and outcome definition was different compared to the development study
Notes	—
Item	Authors' judgement	Support for judgement
Domain 1: Participant selection	Yes	Although only patients undergoing vascular surgery were included, participant selection was appropriate and the RCRI model can be applied in these patients.
Domain 2: Predictors	Unclear	No information on predictor definitions
Domain 3: Outcome	Unclear	No standardised definition of composite outcomes; no information how outcomes were assessed.
Domain 4:  Analysis	No	Low number of outcomes; no estimate reported; no handling of missing data.
Overall judgement	No	Patient selection was appropriate. However, predictors and outcomes definitions were unclear. In addition, the number of outcomes was low, no performance measures were reported and no information on handling of missing data.